What would you do next?

[twoforwardandtwoback]

Position as follows:

• Male 37: MFI, varicocele
• Female 37: low AMH, regular cycles, possible immune issues (positive ANA)

• Nov 21: natural conception, MMC (11 weeks)
• Jun 22: IVF cycle cancelled, poor response
• Jul 22: IVF cycle not started, high FSH
• Aug 22: ICSI, 6 eggs, 1 AA embryo, chemical
• Nov 22: ICSI, 1 egg, 1 embryo, MMC (8 weeks)
• Jan 23: natural conception, TFMR (16 weeks)

Interested in others with similar bumpy journeys and what you'd do as a next step.

Head spinning between following options:

• Operate on varicocele, improve sperm quality, continue trying naturally
• ICSI again, perhaps try a dual-stim cycle
• ICSI again, perhaps natural modified IVF
• time to seriously consider using a donor

Was initially optimist that I've fallen pregnant naturally twice, surely it would happen again? But most recent sperm analysis was the worst ever (1% morphology, 9% motility, count fine). Previous analyses have been more borderline.

Recognise time is running out!

I would say operate on the varicocele as that can really improve sperm quality and count (but quality so important if going for ivf). Then give it a year to try naturally and maybe go for ivf again.
My partner also has a varicocele (2 I think) and we had Icsi ivf and were very lucky to conceive our son (he's 2 in December) but I am 10 years younger than him (I was 25 at the time). I got 17 eggs and 7 fertilised and only one made it to blast good quality. So that shows that the sperm wasn't the best quality.
We now want another baby but will go through the referral process again and my partner will probably have the operation to remove the varicocele even if we end up having ivf again. We have been trying naturally 5 months now and nothing is happening but I don't expect it to either.
Sending you hugs on this difficult journey.